Provider Demographics
NPI:1871256271
Name:BEDFORD, MARY (REGISTERED NURSE,)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:BEDFORD
Suffix:
Gender:F
Credentials:REGISTERED NURSE,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 LINE ST
Mailing Address - Street 2:
Mailing Address - City:MILMAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08340-3303
Mailing Address - Country:US
Mailing Address - Phone:609-470-4087
Mailing Address - Fax:
Practice Address - Street 1:505 W BLACK HORSE PIKE
Practice Address - Street 2:
Practice Address - City:PLEASANTVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08232-2663
Practice Address - Country:US
Practice Address - Phone:609-641-9356
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-21
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NO09204100163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice